Provider Demographics
NPI:1902354483
Name:INDEPENDENCE TECHNICAL SERVICES P.C.
Entity Type:Organization
Organization Name:INDEPENDENCE TECHNICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-200-8262
Mailing Address - Street 1:7000 WEST PALMETTO PARK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:855-200-8262
Mailing Address - Fax:561-584-5849
Practice Address - Street 1:7000 WEST PALMETTO PARK RD STE 205
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:855-200-8262
Practice Address - Fax:561-584-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty